Provider Demographics
NPI:1588079065
Name:ROY CHIROPRACTIC CENTERS PLLC
Entity type:Organization
Organization Name:ROY CHIROPRACTIC CENTERS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIE-CLAUDE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-923-2428
Mailing Address - Street 1:115 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-2011
Mailing Address - Country:US
Mailing Address - Phone:248-923-2428
Mailing Address - Fax:248-656-6958
Practice Address - Street 1:115 E 3RD ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-2011
Practice Address - Country:US
Practice Address - Phone:248-923-2428
Practice Address - Fax:248-656-6958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-24
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009207111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5184054Medicaid
MI2301009207OtherSTATE LICENSE NUMBER
MIWP009063OtherCOMMERCIAL
MIOF33423OtherBCBSM PIN
MI11611173OtherCAQH ID
MI5184054Medicaid